Individual
KEANU GONZALES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1151 DOVE ST, NEWPORT BEACH, CA 92660-2840
(909) 248-3315
Mailing address
1151 DOVE ST, NEWPORT BEACH, CA 92660-2840
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
10/08/2025
Last updated
10/08/2025
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